Criminal Victimization in Rural and Urban Areas: Comparative Analysis

Exact date of working paper unknown

Pulmonary Dysfunction in Patients with Femoral Shaft Fracture Treated with Intramedullary Nailing

Background: This study was undertaken to determine whether alveolar dead space increases during intramedullary nailing of femoral shaft fractures and whether alveolar dead space predicts postoperative pulmonary dysfunction in patients undergoing intramedullary nailing of a femoral shaft fracture. Methods: All patients with a femoral shaft fracture were prospectively enrolled in the study unless there was evidence of acute myocardial infarction, shock, or heart failure. Arterial blood gases were measured at three consecutive time-periods after induction of general anesthesia: before intramedullary nailing and ten and thirty minutes after intramedullary nailing. The end-tidal carbon-dioxide level, minute ventilation, positive end‐expiratory pressure, and percent of inspired and expired inhalation agent were recorded simultaneously with the blood-gas measurement. Postoperatively, all subjects were monitored for evidence of pulmonary dysfunction, defined as the need for mechanical ventilation or supplemental oxygen (at a fraction of inspired oxygen of >40%) in the presence of clinical signs of a respiratory rate of >20 breaths/min or the use of accessory muscles of respiration. Results: Seventy‐four patients with a total of eighty femoral shaft fractures completed the study. Fifty fractures (62.5%) underwent nailing after reaming, and thirty fractures (37.5%) underwent nailing with minimal or no reaming. The mean alveolar dead-space measurements before canal opening and at ten and thirty minutes after canal opening were 14.5%, 15.8%, and 15.2% in the total series of seventy‐four patients (general linear model, p = 0.2) and 20.5%, 22.7%, and 24.2% in the twenty patients with postoperative pulmonary dysfunction (general linear model, p = 0.05). Of the twenty‐one patients with an alveolar dead-space measurement of >20% thirty minutes after nailing, sixteen had postoperative pulmonary dysfunction. According to univariate and multivariate analysis, the alveolar dead-space measurement was strongly associated with postoperative pulmonary dysfunction. Conclusions: According to our data, intramedullary nailing of femoral shaft fractures did not significantly increase alveolar dead space, and the amount of alveolar dead space can predict which patients will have pulmonary dysfunction postoperatively

Assessment of musculoskeletal examination skills of 4th year medical students using a novel OSCE

Objective: Despite the high prevalence of musculoskeletal complaints presenting to physicians in the United States, there are very few opportunities for University of Michigan clinical medical students to receive formative or summative assessment of their ability to evaluate patients with these complaints. The purpose of this study was to assess 4th year students’ ability to examine and diagnose several common musculoskeletal disorders using a novel objective structured clinical examination (OSCE). Methods: A multidisciplinary team of musculoskeletal specialists developed the content and structure of three OSCE stations focusing on examination of the shoulder, back and knee. For each station, volunteer M4 students were provided a clinical vignette with three possible diagnoses to consider, and were instructed to anticipate physical examination maneuvers or findings that would discriminate between the three diagnoses. Then they would examine a professional patient simulating findings associated with one of the diagnoses and choose their favored diagnosis. Their encounter was directly observed by a faculty member who scored their performance on selected physical examination maneuvers based on a checklist (0 = not done, 1 = partially done, 2 = fully done). Each encounter was recorded to allow for later review by another faculty. Immediate feedback was provided to students at the end of the OSCE, making this a formative as well as summative assessment experience. Faculty received verbal and written instruction on how to score students. IRB exemption was obtained for this study. Results: 44 M4 students participated in the OSCE during the spring of 2012. General performance of M4 students in examining regional musculoskeletal complaints will be reported. Performance of individuals will be correlated with: anticipation of discriminatory features prior to examining the patients; self-assessment on ability to perform the relevant exam and anticipated need to do so in their future career; previous musculoskeletal elective exposure; future career choice; and performance on the M4 Comprehensive Clinical Assessment “Back pain” and “Abdominal pain” stations. Conclusions: Initial validity evidence for a multistation musculoskeletal OSCE will be presented, as will the performance of a sampling of the 2012 graduating UM medical student class. This data will be used as part of ongoing evaluation of the longitudinal musculoskeletal curriculum at the University of Michigan medical school.http://deepblue.lib.umich.edu/bitstream/2027.42/91291/1/MedEdDay2012-poster-monradetal.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/91291/3/MEDC22poster.pd

Serum Biochemistry and Inflammatory Cytokines in Racing Endurance Sled Dogs With and Without Rhabdomyolysis

Serum muscle enzymes in endurance sled dogs peak within 2–4 days of racing. The object of this study was to compare mid-race serum chemistry profiles, select hormones, markers of inflammation, and the acute phase response in dogs that successfully completed half of the 2015 Yukon Quest sled dog race to their pre-racing samples (n = 14), as well as mid-race samples of successful dogs to those who developed clinical exertional rhabdomyolysis (ER) (n = 5). Concentrations of serum phosphorus in ER dogs were significantly elevated compared to healthy dogs (median 5.5 vs. 4.25 mg/dL, P < 0.01) at mid race. ALT, AST, and CK show a significant increase from pre-race baseline to mid-race chemistries (P < 0.01), with more pronounced increases in dogs with ER compared to healthy racing dogs (CK- median 46,125 vs. 1,743 U/L; P < 0.01). Potassium concentrations were significantly decreased from pre-race baselines in all dogs (median 5.1 vs. 4.5 mEq/L; P < 0.01), and even lower in dogs with ER (median 3.5 mEq/L; P < 0.01) mid-race. No changes in serum pro-inflammatory cytokine concentrations were noted in any groups of dogs. C-reactive protein was elevated in both groups of dogs, but significantly higher in those with ER compared with healthy dogs mid-race (median 308 vs. 164 ug/mL; P < 0.01). Healthy dogs may have CK elevations over 10,000 U/L, and dogs with ER were over 30,000 U/L. Although potassium decreases in healthy endurance sled dogs during racing, it remains in the normal laboratory reference range; however ER dog potassium levels drop further to the point of hypokalemia. Lastly increases in CRP may be reflective of a physiological response to exercise over the course of a race; however high CRP in ER dogs may be capturing an early acute phase response

Positive Approaches to Phosphorus Balancing in Southwest Missouri: Animal Manure Phosphorus Recycling Initiative

Document presented on July 12, 2001 at Crowder College, Neosho, MO and on November 6 & 7 at Water Quality Research in the White River Basin Conference in Springfield, MO.Opportunities exist to create value added animal waste fertilizer products that can be used in crop production, reducing import demands for phosphorus, and relocating phosphorus from areas of excess supply to areas of need for crop production. This paper focuses on opportunities to recycle poultry litter in southwest Missouri.This project is a cooperative effort of the Food and Agricultural Policy Research Institute at the University of Missouri and the Natural Resource Conservation Service. The work is supported by EPA grant X997396-01, Region VII U.S. Environmental Protection Agency, under section 104 (b)(3). The Missouri Department of Agriculture appropriated funds to support the work in this report

Significant variability exists in preoperative planning software measures of glenoid morphology for shoulder arthroplasty

Background & Hypothesis: We sought to assess the reliability of 4 different shoulder arthroplasty 3-dimensional preoperative planning programs. Comparison was also made to manual measurements conducted by 2 fellowship-trained musculoskeletal radiologists. We hypothesized that there would be significant variation in measurements of glenoid anatomy affected by glenoid deformity. Methods: A retrospective review of computed tomography (CT) scans of patients undergoing shoulder arthroplasty was undertaken. A total of 76 computed tomographies were analyzed for glenoid version and inclination by 4 templating software systems (VIP, Blueprint, TrueSight, ExactechGPS). Inter-rater reliability was assessed via intra-class correlation coefficient (ICC). For those shoulders with glenohumeral arthritis (58/76), ICC was also calculated when sub-grouping by modified Walch classification. Lin\u27s concordance correlation coefficient was calculated for each system with 2 musculoskeletal-trained radiologists’ measurements. Results: Measurements of glenoid version and inclination differed between at least 2 programs by 5º-10º in 75% and 92% of glenoids respectively, and by \u3e10º in 18% and 45% respectively. ICC was excellent for version but only moderate for inclination. ICC was highest among Walch A glenoids for both version (near excellent) and inclination (good), and lowest among Walch D for version (near poor) and Walch B for inclination (moderate). When measuring version, VIP had the highest concordance with manual measurement; Blueprint had the lowest. For inclination Blueprint had the highest concordance; ExactechGPS had the lowest. Discussion & Conclusion: Despite overall high reliability for measures of glenoid version between 4 frequently utilized shoulder arthroplasty templating softwares, this reliability is significantly affected by glenoid deformity. The programs were overall less reliable when measuring inclination, and a similar trend of decreasing reliability with increasing glenoid deformity emerged that was not statistically significant. Concordance with manual measurement is also variable. Further research is needed to understand how this variability should be accounted for during shoulder arthroplasty preoperative planning. Level of Evidence: Level III; Retrospective Comparative Stud

Impact of ionizing radiation on superconducting qubit coherence

The practical viability of any qubit technology stands on long coherence times and high-fidelity operations, with the superconducting qubit modality being a leading example. However, superconducting qubit coherence is impacted by broken Cooper pairs, referred to as quasiparticles, with a density that is empirically observed to be orders of magnitude greater than the value predicted for thermal equilibrium by the Bardeen-Cooper-Schrieffer (BCS) theory of superconductivity. Previous work has shown that infrared photons significantly increase the quasiparticle density, yet even in the best isolated systems, it still remains higher than expected, suggesting that another generation mechanism exists. In this Letter, we provide evidence that ionizing radiation from environmental radioactive materials and cosmic rays contributes to this observed difference, leading to an elevated quasiparticle density that would ultimately limit superconducting qubits of the type measured here to coherence times in the millisecond regime. We further demonstrate that introducing radiation shielding reduces the flux of ionizing radiation and positively correlates with increased coherence time. Albeit a small effect for today's qubits, reducing or otherwise mitigating the impact of ionizing radiation will be critical for realizing fault-tolerant superconducting quantum computers.Comment: 16 pages, 12 figure

Multi-Messenger Gravitational Wave Searches with Pulsar Timing Arrays: Application to 3C66B Using the NANOGrav 11-year Data Set

When galaxies merge, the supermassive black holes in their centers may form binaries and, during the process of merger, emit low-frequency gravitational radiation in the process. In this paper we consider the galaxy 3C66B, which was used as the target of the first multi-messenger search for gravitational waves. Due to the observed periodicities present in the photometric and astrometric data of the source of the source, it has been theorized to contain a supermassive black hole binary. Its apparent 1.05-year orbital period would place the gravitational wave emission directly in the pulsar timing band. Since the first pulsar timing array study of 3C66B, revised models of the source have been published, and timing array sensitivities and techniques have improved dramatically. With these advances, we further constrain the chirp mass of the potential supermassive black hole binary in 3C66B to less than $(1.65\pm0.02) \times 10^9~{M_\odot}$ using data from the NANOGrav 11-year data set. This upper limit provides a factor of 1.6 improvement over previous limits, and a factor of 4.3 over the first search done. Nevertheless, the most recent orbital model for the source is still consistent with our limit from pulsar timing array data. In addition, we are able to quantify the improvement made by the inclusion of source properties gleaned from electromagnetic data to `blind' pulsar timing array searches. With these methods, it is apparent that it is not necessary to obtain exact a priori knowledge of the period of a binary to gain meaningful astrophysical inferences.Comment: 14 pages, 6 figures. Accepted by Ap